Outcomes and Need for Additional Interventions after Intravitreal Bevacizumab for Retinopathy of Prematurity

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This study investigated the outcomes of premature infants diagnosed with retinopathy of prematurity (ROP) that were treated with intravitreal bevacizumab (IVB), as well as the need for further treatment after injection. Retrospective case series. Seventy-three premature infants born between 2016 and 2020 at a large county hospital and children's hospital. Chart review was performed and patient demographics, neonatal intensive care unit (NICU) course, ROP exams, and treatment were collected. Rates of recurrent ROP disease, complete vascularization, persistent avascular retina (PAR), as well as rates of secondary and tertiary laser photocoagulation, IVB, or pars plana vitrectomy. Infants included in this study were born at a median gestational age (GA) of 24.6 weeks (range, 23.0-30.1) and a median birth weight of 670 g (range, 370-1080). Patients received their IVB injection at a median postmenstrual age (PMA) of 36.4 weeks (range, 16.0-87.9). Five patients died during their NICU course and did not have long-term follow-up. Of the remaining patients, 24 (33%) experienced complete vascularization after 1 injection; 13 (18%) experienced regression followed by disease recurrence necessitating additional interventions; 5 (7%) had persistent disease and did not experience any regression requiring laser treatment or a second IVB injection; and 26 (36%) experienced regression with PAR. Patients with persistent or recurrent ROP had a significantly lower GA than other patients in the study (P < 0.05). For one-third of premature patients, 1 IVB injection was sufficient for ROP regression and complete vascularization of the retina. The remaining patients required some form of additional intervention after their injection, with a majority receiving laser for PAR. One-fifth of patients experienced disease recurrence up to 58 weeks PMA. Future studies should be performed on PAR prevalence and presentations to explore how long patients with PAR should be monitored. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.